Insular Glioma Systematic Reviews and Meta-analysis [Neurosurgery Wiki]

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====== Insular Glioma Systematic Reviews and Meta-analysis ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1rYqyBTl7b-QGg_m2Xs0Qacv4RZEs7GV_OSr95F4t2usIDa19i/?limit=15&utm_campaign=pubmed-2&fc=20250605113229}}

A [[Systematic Review]] and [[Meta-analysis]] of Matthias Simon et al., estimated rates of motor and speech deficits epilepsy control, KPI, and functional outcomes, surgical approaches and intraoperative strategies, gaps and open research questions

===== 📊 Methodology =====

  * [[Literature search]] and [[inclusion criteria]] were clearly defined.
  * [[Pooled data]] using a **random-effects model**.
  * [[PRISMA]] flowchart included in the full text.

**Strengths**:
  * Solid meta-analytic approach
  * Wide timespan and adequate [[sample size]]

**Limitations**:
  * No formal risk-of-bias assessment reported
  * Lack of subgroup analyses by tumor grade or patient characteristics

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===== 📈 Main Results =====

  * **Motor deficits**: 6.8%
  * **Speech deficits**: 3.6%
  * **Postoperative epilepsy control**: 79.6%
  * **KPI ≥ 80**: 83.5%

**Technical Insights**:
  * **Awake surgery**: Slightly better functional outcome, but possibly less extent of resection
  * **Transcortical approach**: Fewer motor deficits than transsylvian

**Limitations**:
  * Pooled results do not reflect institutional variability
  * Lack of detail on long-term seizure outcome (e.g., Engel class)

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===== 🧪 Discussion and Interpretation =====

  * Risks and complication rates are comparable to other neuro-oncological procedures.
  * Mapping and monitoring are **recommended**, ideally in experienced hands.

**Criticisms**:
  * Underrepresents the steep [[insular glioma surgery learning curve]] and required surgical [[expertise]]
  * No GRADE assessment of evidence
  * Brief treatment of **insular glioblastomas**

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===== ❗ Literature Gaps Identified =====

  * Absence of standardized functional outcome reporting
  * Poorly defined classification systems (Yasargil vs. Berger-Sanai vs. Duffau)
  * Limited evidence on high-grade (GBM) surgery in insula

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===== 📌 Final Assessment =====

^ Category ^ Assessment ^
| **Study Type** | Systematic Review + Meta-analysis |
| **Methodological Rigor** | High (PRISMA, random-effects model) |
| **Heterogeneity Handling** | Moderate (no deep stratification) |
| **Clinical Applicability** | High for experienced centers |
| **Addresses Gaps?** | Partially |
| **Overall Value** | **** (4/5) |

----

===== 📝 Recommendations =====

  * Highly valuable reference for experienced neuro-oncology teams.
  * Not generalizable to centers with limited awake surgery capacity.
  * Future work should focus on:
    * Standardized outcomes
    * Prospective multicenter registries
    * Better classification of insular gliomas and their growth patterns
((Simon M, Hagemann A, Gajadin S, Signorelli F, Vincent AJPE; EANS Neuro-oncology Section. Surgical treatment for insular gliomas. A systematic review and meta-analysis on behalf of the EANS neuro-oncology section. Brain Spine. 2024 May 15;4:102828. doi: 10.1016/j.bas.2024.102828. PMID: 38859917; PMCID: PMC11163152.))